As everyone is well aware of by now, the Supreme Court ruled this morning on the constitutionality of the Patient Protection and Affordable Care Act. The Court upheld the law, including the individual mandate–but under the taxing power, not the Commerce Clause.

Additionally, the Court decided that states are not required to take part in the expansion of Medicaid, and if they decide not to, they will not lose all federal matching funds. SCOTUSblog summarizes:

The bottom line is that: (1) Congress acted constitutionally in offering states funds to expand coverage to millions of new individuals; (2) So states can agree to expand coverage in exchange for those new funds; (3) If the state accepts the expansion funds, it must obey by the new rules and expand coverage; (4) but a state can refuse to participate in the expansion without losing all of its Medicaid funds; instead the state will have the option of continue the its current, unexpanded plan as is.

Medicaid is a major driver of state health care spending. As we wrote in the Thrive Washington paper, Containing State Health Care Spending While Improving Outcomes,

The Kaiser Commission on Medicaid and the Uninsured estimates that the Medicaid expansion provisions of the new federal law will increase spending in Washington state by $8.65 billion from 2014 to 2019. Over the five-year period, the state’s share will rise $380 million, an increase of 1.2 percent over baseline projections. The federal government will fund the additional $8.27 billion. This is over and above baseline Medicaid spending in Washington of $63.7 billion from 2014 to 2019, of which the state would pay $31.8 billion.

It will be interesting to see how the decision on Medicaid plays out in Washington.

The health benefit exhanges portion of the law were not affected by the ruling, so implementation will continue, full speed ahead. We wrote about Washington's implementation of an exchange here.

Lastly, I enjoyed this take on the ruling, from The Economist's ever-interesting Johnson blog (on language):

If we stayed with the Commerce-clause reasoning alone ("no commerce exists here, and Congress was not granted the power compel it into existence"), America's health-care reform would be fatally wounded right now.

Instead, Justice Roberts did some other, slightly fancier, work with implicature. He argued that there was never any "mandate" to buy insurance: the word does not appear (in the relevant context) in the law. Rather, those who don't carry insurance must pay a "penalty", which the law also called a "shared responsibility payment". Writing for a 5-4 majority, Justice Roberts wrote that since this was going to be collected by the Internal Revenue Service, and it was not a criminal offence to forgo health insurance (you could simply pay the "shared responsibility payment" instead), there was no mandate in the first place, merely a "tax". Never mind that the drafters didn't call it a "tax". Congress could have called it a "kazoo", in Justice Roberts's theory. The court held that it looked enough like a tax for its constitutionality to be judged on Congress's power to tax. . . .

So the "mandate" (which isn't a "mandate", in this ruling) is constitutional because it's really just an implied "tax". QED. . . .

[J]udges shouldn't rely too heavily on dictionaries to define words for their rulings. The courts' own judgments can define words. We see a good example of that here.